Physicians, Pharma Trade & Industry should co-operate
with each other remaining within the ethical boundaries
Panel Discussion during PAMI Conference at UOL
LAHORE: It was for the first time that the topic of Physicians interactions with Pharma Trade & Industry related to organization of medical conferences, seminars, symposia and all other academic activities was discussed openly in a meeting which was largely attended by healthcare professionals. It happened during the Third International Conference jointly hosted by Superior University and University of Lahore under the auspices of Pakistan Association of Private Medical & Dental Institutions (PAMI) wherein the organizers did not seek any financial assistance from the pharma industry. Not only that but the participation of the Pharma representative was also sponsored by the organizers which was also a unique. The initiative was taken by Prof. Muhammad Akbar Chaudhry Dean at Superior University and this particular panel discussion was held on the second day of the conference April 12th 2025 at University of Lahore.
Prof. Rehan Ahmad Khan
This session was moderated by Prof. Rehan Ahmad Khan Prof. of Surgery and an eminent medical educationist at Riphah University Islamabad. The Panelists included Prof. M. Akbar Chaudhry from Superior University, Syed Jamshed Ahmed from PharmEvo Pharmaceuticals who represented the pharma industry, Prof. Mughees Baig an expert in Health Policy and Bioethics from University of Lahore, Mr.Shaukat Ali Jawaid Chief Editor Pakistan Journal of Medical Sciences and Pulse International who is also Secretary of Eastern Mediterranean Association of Medical Editors (EMAME) and Prof. Alia Bashir Clinical Practitioner and Medical Administrator.
In his introductory remarks Prof.Rehan Ahmad Khan stated that the relationship between the physicians and Pharma trade and industry when navigated ethically can lead to meaningful medical innovation and better patient outcome. However, when integrity is compromised, trust is eroded with the result that it is the healthcare system which suffers. Financial inducement, biased prescription patterns, sponsored education and lack of transparency have raised red flags globally. Ethical grey zones often arise in Continuing Medical Education (CME) pharma funded conferences and physician’s consultancy roles. The objective of today’s panel discussion, he said, was to understand ethical principles and codes of conduct to exploring real world challenges and find solutions. We have experts from medical academia, pharma industry, medical journalism and policy offering diverse insights. Given below are the excerpts from the discussion.
Prof. Rehan Ahmad Khan: Could you help us define what ethical integrity means in the context of the physician-pharma relationship?
Prof. M. Akbar Chaudhry: Mr. Shaukat Ali Jawaid is the culprit who some time ago published a column in Off the Record in Pulse Internaitonal stating that Billions of rupees were spent by the pharma trade and industry during the last year on medical conferences and other academic activities. Hence, we decided to take up this issue for this conference so that this issue could be discussed openly. Physicians cannot work in isolation. Pharma industry and doctors are just like Husband and Wife and they have to live together peacefully. However, it is extremely important that we do not cross limits and ethical boundaries. By working together and upholding professional ethics, we can do wonders.
Prof. Rehan Ahmad Khan: How can physicians practically safeguard their clinical autonomy while still engaging and collaborating with the pharma trade and industry in areas like research, sponsorship of CME activities?
Prof. M. Akbar Chaudhry: There are over seven hundred pharmaceutical companies and over one hundred thousand products. There are more than few dozen products of the same molecule hence there is lot of competition with the result that some companies started offering incentives to increase their sales. The problem starts here. In drug trials data is sometimes fabricated, manipulated to come up with positive results and then these results are shared with the healthcare professionals. For this conference we did not seek any financial assistance from the pharma industry even the participation of the pharma representative was sponsored by the conference organizers. While treating patients if we ourselves think will we be treating ourselves and our relatives the same way? Drug Regulatory Authority of Pakistan (DRAP) should be provided funding and then it should offer financial assistance to the conference organizers besides sponsoring all other academic activities. At the same time there should be some sort of monitoring and accountability should be ensured.
Panel discussion on Physicians interaction with Pharma Trade and Industry was one of the important salient features of the Third International Conferenced of PAMI held at UOL on second day of the conference. This session was moderated by Prof. Rehan Ahmad Khan. Picture shows the Panelists sitting on the dais from (L to R) Syed Jamshed Ahmed from PharmEvo Pharmaceuticals, Prof. Alia Bashir, Mr. Shaukat Ali Jawaid Chief Editor Pakistan Journal of Medical Sciences, Prof. M. Akbar Chaudhry Dean AZNMDC and Prof. Mughees Baig from UOL.
Prof. Rehan Ahmad Khan: From the industry perspective how does a pharma company ensure that its promotional activities and physicians engagement comply with ethical marketing practices?
Syed Jamshed Ahmed: We do not work in isolation. We do have some good role models. There is deteriorating of moral values in the society as a whole and healthcare professionals are also part of this society. In PharmEvo when we hire any new staff, we tell them the Do’s and Don’ts. We strictly follow professional ethics. We do not sponsor healthcare professionals visits abroad; we do not give any personal favors. However, we do provide facilities in medical institutions for professional capacity building through seminars, symposia, workshops, training sessions. We do provide research grants. In the beginning some of our colleagues in the pharma industry thought that we won’t survive and this company will wind up in few years but since we were sincere in our efforts we succeeded in earning Trust and Respect of the healthcare professionals. For the last twenty-six years we have earned a respectable positon in the pharma industry, we have set some traditions in ethical marketing which now some other companies have also started following. We are now exporting our products to forty countries in the world, we enjoy integrity and good reputation among the healthcare professionals within the country as well. We are one of the WHO Accredited drug manufacturing facility in Pakistan.
Prof. Rehan Ahmad Khan: Can you share any real-life framework or internal controls that your organization uses to discourage undue influence or conflict of interest?
Prof Mahwish Arooj Principal UCMD at University of Lahore along with Sumaira Rehman Rector of Superior University, Prof. M. Ashraf Rector UOL and Prof. Mughees Baig presenting a Mementoes to Prof M. Akbar Chaudhry Dean of Azra Naheed Medical & Dental College at the inaugural session of Third International Conference of PAMI held at UOL on April 12th 2025.
Syed Jamshed Ahmed: Any of our staff found involved in unethical promotional activities is immediately fired and this sets a benchmark for all others. In one instance we received a request from a healthcare professional from a medical institution to provide air conditioners for the comfort of patients sitting in the Out Patients Department and we did provide some Air conditioners. The request was received through our Area Manager. However, when we checked we found out that the reconditioners instead of being installed in the OPD were installed at the residence of the physicians, hence the Area Manager was immediately sacked. We keep a strict watch on our marketing team and anyone involved in any unethical marketing practice is fired. The areas in which we cooperate and collaborate with the healthcare professionals in research and academic activities have been clearly stated and the marketing team is supposed to follow that in letter and spirit.
Prof. Rehan Ahmad Khan: How should we train the future physicians in ethics related to pharma industry relationship during the undergraduate and postgraduate education? Have you come across any successful curricular models or simulated based methods that have improved ethical decision making in real life scenario?
Prof. Mughees Baig: We do need proper code of conduct for healthcare professionals. Marketing tools, moral values and character building has to be integrated in the curriculum. In our environment we have to prescribe some iron, calcium preparations and other multivitamins. The number of pharma companies has increased and they compete with each other to increase their share in overall sales and use at times unethical ways to promote their products. It is a two- way traffic. Pharma industry offers incentives through unethical practices and the physicians get involved. Regulatory bodies in the government must monitor all this. We should have some funding for Research, funding for students’ scholarships, funding for postgraduates to undertake research. Hence we need a balanced approach and both physicians and pharma industry have to work together. Institutional culture is also very important. At present there is lack of trust between public and the healthcare professionals.
Prof. Rashid Latif an eminent obstetrician & gynecologist and founder of Rashid Latif Medical & Dental College was honoured with Life Time Achievement Award by PAMI. Photograph shows flower bouquet being presented to him on his arrival at the conference venue. Prof. Khalid Masood Gondal VC FJMU is also seen in the picture.
Prof. Rehan Ahmad Khan: What role the media has played in exposing ethical breaches or conflict of interest between pharmaceutical companies and the physicians?
Shaukat Ali Jawaid: Let me first of all share some background information. I started my professional love affair with medical journalism in 1966. In late 60s and during 70s, there used to be only one annual symposium of Jinnah Postgraduate Medical Center in Karachi which used to last for one week. It used to attract speakers from all over the country. It was considered an honour to be invited as a speaker at the symposium. Only tea and cookies used to be served during Tea Break and there was no Lunch. The scientific programme was prepared by the scientific committee and presentations were carefully selected. The situation started changing in early 80s when some professional specialty organization were established and they started organizing their conferences. Then we saw the birth of numerous professional specialty organizations not only that even more than two or three specialty organizations within one specialty.
For some it provided a unique opportunity to make money. First the stall in the pharma exhibition at the conference venue used to cost Rs. Ten thousand which now costs from two to ten million rupees. The industry is also asked to arrange not only travel of the speakers and delegates but also pay for their registration, the registration fee has increased from two to five hundred rupees to twenty to twenty-five thousand rupees. It is in fact another way of collecting funds since the registration fee is also sponsored by the pharma industry. These conferences and all academic activities shifted to Five Star Hotels. With the involvement of Event Organizers, the hotel charges also increased almost double. The conference organizes book hotel rooms at actual or concessional rates but sell it to the pharma industry at highly inflated rates. The Pharma industry being vulnerable, have to pay all this. Those not cooperating are coerced, blackmailed and threatened of boycott.
Having witnessed all this during the last five decades, I have come up with some categories of these participants which can be described as under:
Some of the participants of the Third International Conference of PAMI photographed during the tea break at University of Lahore.
Collectors: These delegates and participants can be seen collecting tissue paper boxes, pen, pencils, pads and any other giveaways from the pharmaceutical exhibition stalls. They can be seen with bags and sometime they even drop the collected material in the car or their hotel room and visit the stalls again to collect such materials. Having found out all this, some companies now even provide big bags to these collectors with the company name or product name.
Stalwarts: This category of conference participants can be seen sitting at pharma company stalls and even some of them find it a unique opportunity to negotiate with different companies their visits abroad or holiday tours within the country and overseas. Since representatives of numerous pharma companies are present at the Pharma Exhibition, they find it very convenient to contact different companies.
Outstanding Delegates: These are the one who come to these conferences for social networking, meeting friends and colleagues. They can be seen standing in the corridors or outside the conference halls and different other areas at the conference venue. All the above three categories are least interested in scientific programme, however, they do peep in sometime in the conference hall to see what is happening. While one can find just fifty to one hundred or so people sitting in the conference halls, the number of participants increases manifold just before the Tea, Lunch or Dinner. That is why some speakers prefer to make their presentation before tea or lunch time.
Delegates interested in scientific programme: The number of these delegates and participants is not much. It includes speakers, chairpersons, panelists, organizers and those who are really interested in learning and updating their knowledge. They actively participate in the discussion, make the proceedings lively. Their number can be increased if the scientific programme is interesting and the presenters are experts in their field.
Unfortunately, a vast majority of these medical conferences organized at Five Star Hotels are social get-togethers of healthcare professionals with their families. The scientific contents are very little and it may vary from 20% to 40% and the rest if recreation and socialization. The pharma companies providing financial assistance in various forms dictate the scientific programme.
Just to give a few examples the psychiatric conference at Abbottabad had nine speakers all speaking on one product marketed by a multinational pharma company who had sponsored their visit. At another conference in Peshawar, the invited guest speakers which included President of a Royal College from UK and another renowned speaker from United States kept on waiting till 9.45 AM as there was no audience. The Chairman of the scientific committee had to call delegates in their hotel rooms and those having breakfast to request to come to the conference hall so that the session could be started. In yet another case an invited speaker from Saudi Arabia refused to make a presentation at a conference being held at Hotel Sarena in Faisalabad as there were no audience till 9.45 AM and he was the first speaker in the session which was supposed to start at 9.00 AM.
The organizes faced lot of embarrassment as participants were either resting in their hotel rooms or still busy in breakfast. Having failed to ensure the present of participants, the organizes turned for help to their colleagues in the Pharma Trade and Industry and asked those sitting at the Pharma Exhibition stalls to come to the conference hall so that the programme could be started. In yet another case the organizers of a conference in Peshawar booked the only hotel rooms and all the rooms in Guest Houses in Peshawar and then sold it at triple the price. Since there is only one big hotel apart from a few small hotels, the pharma companies who had sponsored their delegates had no other option but to pay this inflicted rate to accommodate their sponsored guests.
In another international conference there were twenty-one presentations on a single product marketed by a multinational company spread in different sessions on three days of the conference. On the last day a delegate from South Africa stood up and remarked that he made a mistake of coming to this conference. You seem to have no other problem; you all seem to be sold to one drug which perhaps is “Abe Zamzam” for you. One can cite many more such episodes. Just imagine what impression these foreign delegates coming to these conferences will carry.
A British delegate at one of the international conferences looking at the lavish arrangements, provision of expensive gifts, mementoes etc., remarked that we cannot afford all this in UK. You can even give Aid to UK instead of asking for loans from overseas. In a joint meeting with Bangladesh held at Five Star Hotel which was hosted by the Pakistani counterpart, there was lavish arrangements and one could see delegates and participants from Bangladesh taking food standing in que. I asked the delegates from Pakistan to learn this discipline from the colleagues from Bangladesh. On the contrary hosts organized the conference Banquet at their institution campus and every one was provided Biryani packet with a plate and bottle of water. It was about twenty years ago. The situation there might have also changed but still they provide simple food very economical which they can afford. This is one of the reasons that the economic situate and even health indicators of Bangladesh are much better than Pakistan.
It is not all. Even lacs of rupees are paid to the renowned singers who are invited at the conference dinners and social programme and all this is paid by the pharma industry. The healthcare professionals do not realize the fact that each lunch and dinner taken by the conference delegates deprive few patients of their mediations. Pharma trade and industry is not a charity, they all pass it on to the patients in the form of costly investigations, and increased price of drugs and medicines which many cannot afford. Hence it leads to non-compliance with pharmacotherapy, treatment failure, development of resistance and increased morbidity and mortality. Many of these things can be avoided.
Having shared all the above information, I must add that there are exceptions. Now the situate is gradually changing. The scientific contents of conferences organized by some professional specialty organizations is much better though the attendance in scientific sessions remains a problem. Some have now active functional Scientific Committees who prepare the scientific programme and do not allow the industry to select speakers and interfere with the scientific programmed.
I refused advertisement contract worth six lac rupees twenty years ago from a multinational company as I did not like their marketing and promotional strategy which was highly unethical. I do not do business with those companies who are known for unethical marketing practices. As a founder member of the National Bioethics Committee, I prepared a draft of Guidelines for Healthcare Professionals interaction with Pharma Trade and Industry with the help of a few colleagues from pharma industry, PM&DC was also taken on board. This draft was discussed in the NBC meeting for almost a year, some members did give their input particularly Prof. Farhat Moazzam before it was approved by the NBC, PM&DC and the Federal Health Ministry. However, it has never been implemented for a single day. It has always been a pleasure to attend conferences at University of Lahore, Superior University, Rehman Medical Institute, Shalamar Medical & Dental College, Aga Khan University, SIUT as they organize it at their campuses and they are always very well attended.
Prof.Rehan Ahmad Khan: How can Journal Editors and Medical Journalists promote ethical integrity, particularly in sponsored content or conference coverage?
Shaukat Ali Jawaid: I have been pointing out all these unethical practices. If I am present in the meeting or conference and do see such unethical practices, I make it a point to highlight it. I am not ashamed to name and shame individuals, institutions, organizations involved in such unethical practices. Eventually it had its impact and gradually the situation is improving. We no longer see company and product banners in conference halls, speakers are afraid to show company prepared presentations with company logo and brand name of the drug. A few speakers have started disclosing their sponsorship before making presentation. Company sponsored Satellite Symposia are now transparent. Company sponsorship is disclosed and this transparency is welcome. There is no harm in pharma company sponsoring doctors’ participation in medical conferences at home and abroad but it must be transparent. The delegates should attend conferences which will help in building their professional capacity and thus also improve patient care, teaching and training. But what happens that most of these delegates instead of attending conferences spend most of the time in sightseeing and tours which is objectionable.
Conference dinner should be contributory instead being sponsored by the pharma industry. Those who are interested can attend and it should not be mandatory. Conferences organizers should desist from entertaining their friends, relatives and influential people from the society at such pharma sponsored dinner and musical programmes. If they are keen to listen to famous singes, let them pay for it and not expect the poor patients to pay for all that.
Pharma Exhibition at the conference venue should be closed and opened only at the time of tea break or lunch time. The younger generation of healthcare professionals will follow their seniors and they have to become role models. I have been constantly highlighting all these unethical activities at conferences and other academic activities. I wish and pray that the medical profession comes back to the lecture halls and auditoriums of medical institutions from Five Star Hotels. It provides not only an academic environment; participation is much more and it is also highly economical to organize these meeting. It there is no worthwhile contents to present, the specialty organizations can hold their meetings biannually rather than annually and even Mid-Summer meeting organized by some specialty organizations can be eliminated. The physicians must remember that all such activities have spoiled their image in the society. Le the Deans, Principals of medical and dental colleges, Vice Chancellors of Medical Universities, professional specialty organizations monitor their members. I have always advocated and promoted the concept of “Self-Monitoring and Self Accountability” and if the profession fails to do that, someone else will start monitoring and then it will be very painful for them.
Prof. Rehan Ahmad Khan: As a clinical teacher’s perspective what are the common ethical dilemmas you observe in your institution related to interaction with pharma industry and what organizational policies of culture building initiatives have you found effective while allowing beneficial collaboration?
Prof. Alia Bashir: One can organize a Central Drug Bank in the hospital and all samples donated can be stored there and patients who need drugs can be referred there. The industry can offer financial assistance to the institution and then the administration can effectively utilize it for the improvement of teaching, training, and patient care. Many important issues have been highlighted by various panelists. There are ways and means to promote this collaboration between the clinicians and pharma industry which can be beneficial to both of them but at the same time upholding professional ethics.
Quite a few participants actively got involved in the discussion. One of the participants pointed out that medical representatives sit at Pharmacy shops and change the doctor’s prescription replacing the prescribed drugs with products of their own company. This also goes on unchecked. Some suggested that we need to promote code of conduct, uphold professional ethics and conscious, healthcare professionals can play a vital role. We must have some role models. Ethics cannot be taught, it is promoted through actions and observations. Prof. Akbar Chaudhry referred to a recent study in which 50% of the doctors in the survey refused to accept any incentives but later it became known that most of them had already committed to some other company. Bribing the doctors by some unethical pharma companies is no more a secret but is well-known. DRAP and Ministry of Health need to monitor all this.
In his concluding remarks Prof. Rehan Ahmad Khan said that ethics and integrity are not just ideals, they are actionable standards. Pharma and Physicians can collaborate ethically when transparency, education and policy work in unison. Institutions Prof. Rehan remarked must lead with example through guidelines, training and organizational culture. I hope the participants are now well informed and more committed to restoring and retaining the trust placed in us by patients and the society.
